Research and Development Center, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Saadat-Abad, Tehran, Iran.
J Cardiothorac Vasc Anesth. 2012 Aug;26(4):631-6. doi: 10.1053/j.jvca.2011.11.013. Epub 2012 Jan 29.
The aim of this study was to clarify the efficacy of perioperative glucose-insulin-potassium (GIK) infusion on preoperative and postoperative N-terminal (NT)-pro-brain natriuretic peptide (BNP) concentrations in patients with a low ejection fraction undergoing isolated on-pump coronary artery bypass graft (CABG) surgery.
A double-blind, randomized, controlled study.
Modarres Hospital, Tehran, Islamic Republic of Iran.
Sixty-six patients with a low ejection fraction who required coronary artery surgery were selected.
Patients were allocated to a GIK (n = 36) or a control (n = 30) group. The GIK group received GIK solution (500 mL of dextrose in water (DW) 10% + 40 U of regular insulin + 40 mEq of KCl, and 2 g of MgSO(4)) at a rate of 1 mL/kg/h for 10 hours preoperatively and until the removal of the aortic cross-clamp. The control group received half saline solution as placebo with an equivalent infusion rate during the same interval.
Serum NT-proBNP levels were measured before starting the GIK, at the time of anesthesia induction, and 24 hours after surgery. The primary outcome measures were preoperative and postoperative NT-proBNP level. The amount of elevation in postoperative NT-proBNP concentrations was less prominent in the GIK group than in the control group (2,601 ± 1,799 pg/mL v 4,732 ± 4,127 pg/mL; p = 0.02). The patients in the GIK group were extubated sooner (495 ± 92 minutes) than the control group (774 ± 224 minutes; p = 0.002). The overall extubation time was 606 ± 177 minutes. Delayed requirement for mechanical ventilation was significantly more in the controls compared with the GIK group (45.8% v 13.9%, p = 0.004).
GIK is of value in the reduction of post-cardiac surgery NT-proBNP elevation. Thus, its infusion should have a protective effect in patients with low ejection fraction undergoing CABG surgery. Further studies may prove GIK infusion benefits in high-risk CABG surgery patients optimize outcome.
本研究旨在阐明术前置与术后 N 末端（NT）-脑利钠肽前体（BNP）浓度在接受体外循环冠状动脉旁路移植术（CABG）的低射血分数患者中，围手术期葡萄糖-胰岛素-钾（GIK）输注的疗效。
双盲、随机、对照研究。
伊朗德黑兰 Modarres 医院。
选择了 66 名射血分数较低的需要冠状动脉手术的患者。
患者分为 GIK（n = 36）或对照组（n = 30）。GIK 组在术前 10 小时以 1 mL/kg/h 的速度输注 GIK 溶液（10%葡萄糖 500 mL+普通胰岛素 40 U+KCl 40 mEq 和 2 g 硫酸镁），直至主动脉阻断夹移除。对照组在同一时间段内接受半盐水溶液作为安慰剂以相同的输注速度。
在开始 GIK 之前、麻醉诱导时和手术后 24 小时测量血清 NT-proBNP 水平。主要观察指标为术前和术后 NT-proBNP 水平。GIK 组术后 NT-proBNP 浓度升高幅度低于对照组（2,601 ± 1,799 pg/mL 比 4,732 ± 4,127 pg/mL；p = 0.02）。GIK 组患者的拔管时间更早（495 ± 92 分钟），而对照组为 774 ± 224 分钟（p = 0.002）。总拔管时间为 606 ± 177 分钟。对照组机械通气需求延迟明显多于 GIK 组（45.8%比 13.9%，p = 0.004）。
GIK 可降低心脏手术后 NT-proBNP 升高，因此在接受 CABG 手术的低射血分数患者中，其输注具有保护作用。进一步的研究可能会证明 GIK 输注对高危 CABG 手术患者有益，优化预后。
